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Grzegorz Opolski

Publications and source records attributed to Grzegorz Opolski.

At least 19 recordsLinked to original sources
PubMed2007

Prognostic implications of myocardial necrosis triad markers' concentration measured at admission in patients with suspected acute coronary syndrome.

The aim of the study was to analyze the prognostic implications of 3 myocardial necrosis markers measured at admission in short-term observation of patients with suspected acute coronary syndrome. The study group consisted of 336 consecutive patients whose concentration of cardiac troponin I, creatine kinase-MB fraction, and myoglobin were measured at admission. All patients referred due to chest pain and suspected acute coronary syndrome and were followed up for 30 days. The patients who died had statistically higher concentration of cardiac troponin I (8.7 +/- 17.2 vs 0.9 +/- 3.2 ng/mL; P = .0006), myoglobin (215.2 +/- 181.5 vs 109.7 +/- 151.5 ng/mL; P = .003), and creatine kinase-MB (21.9 +/- 30.7 vs 8.8 +/- 25.9 ng/mL; P = .005), compared to patients who stayed alive. There was statistically significant increase in 30-day all-cause mortality with increasing numbers of positive markers-0.6% for patients with nonpositive marker, 3.4% for patients with 1 positive marker, and 11.5% for patients with at least 2 positive markers (P = .001 for trend).

Aged↗
PubMed2006

Previously undiagnosed congenitally corrected transposition of the great arteries in a 51-year-old woman with chronic heart failure symptoms.

We describe the case of a 51-year-old female with previously undiagnosed congenitally corrected transposition of the great arteries (ccTGA) who was admitted to the hospital due to the exacerbated symptoms of heart failure for planned coronary angiography. Patient cardiac functional status appeared to have gradually regressed to New York Heart Association class III at the time of the admission. The chart reviews were performed. Coronary angiography did not reveal the occlusion of the coronary artery. Radiography, echocardiography, and multislice computed tomography confirmed newly diagnosed ccTGA.

Coronary Angiography↗
PubMed2006

Long-term sinus rhythm maintenance after cardioversion of persistent atrial fibrillation: is the treatment's success predictable?

The aim of our study was to identify the clinical and echocardiographic predictors of long-term success of cardioversion in patients with persistent atrial fibrillation (AF). Our study comprised 104 patients (F/M 33/71; mean age 60.4 +/- 7.9 years) assigned to SR restoration and maintenance with sequentially administered antiarrhythmic drugs. Their clinical and transthoracic echocardiographic (TTE) variables were recorded prior to cardioversion and examined for correlation with sinus rhythm (SR) maintenance at 1 year. The variables under consideration included age, gender, echo parameters such as long and short left atrial (LA) axis, LA and right atrial (RA) area, fractional shortening (FS) and left ventricular end-diastolic diameter, AF duration, New York Heart Association functional class, and concomitant diseases. Generalized additive logistic regression method was used to investigate impact of the selected variables on long-term SR maintenance. At 1 year, SR was present in 63.5% of patients. Left atrium area (LA(ar)) > 28 cm (P < 0.02) and FS value >26% (P < 0.05), both measured at baseline, were significantly associated with SR maintenance after 1 year. Patients with large LA(ar) values (>28 cm(2)) presented a significant decrease (31.45 +/- 3.07 cm(2) vs 28.94 +/- 3.81 cm(2); P < 0.008) during 30 days following SR maintenance. In patients with LA(ar) >28 cm(2) we noted an atrial decrease of 2.57 +/- 3.2 cm(2) (P < 0.004) during 30 days following SR restoration, which turned out to be an independent factor related to SR presence at 1 year of follow-up (relative risk 1.83; 95% confidence interval: 1.03-2.95; P < 0.01). Of all the considered variables only LA area and FS value seem to be relatively reliable predictors of SR sustainability at 1 year after an effective cardioversion of persistent AF.

Aged↗
PubMed2006

The cost comparison of rhythm and rate control strategies in persistent atrial fibrillation.

UNLABELLED: Our sub study was designed to analyze the cost effectiveness of two alternative treatment strategies with a view to improved allocation of the limited therapeutic resources. To that effect we conducted detailed analysis of the related costs and other relevant data collected in the course of the HOT CAFE study. METHODS: The prospective costs related to 205 patients randomly assigned to rhythm or rate control were traced over a 12 month period. Since, both strategies produced similar clinical outcomes a cost minimization analysis was undertaken. The cost of diagnostic and treatment procedures, including hospitalization, outpatient visits, drugs and physicians consultations were estimated for both groups. RESULTS: The study population comprised 205 patients (mean age 60.8 year; 35% females). A hundred and one patients were randomly assigned to the rate control group with the pharmacological heart rate frequency optimization treatment combined with Holter monitoring. A hundred and four patients were randomized to sinus rhythm (SR) restoration with its subsequent maintenance with sequential antiarrhythmic drug treatment. There was no significant difference in the composite primary end-point (all-cause mortality, number of thromboembolic and major bleeding events). The hospital admissions rate was significantly higher in the rhythm control than the rate control arm (202 vs. 5, respectively). The conservative strategy involving pharmacological ventricular rate control proved to be less costly than rhythm control (1225 euros vs. 2526 euros; p<0.001). The main cost driver behind the established difference was the cardioversion related hospitalization. CONCLUSIONS: The cost effectiveness appraisal seems to have supported the rate control strategy as less costly due to the lower hospitalization rate as a major cost carrier.

Analysis of Variance↗
PubMed2006

Admission B-type natriuretic peptide assessment improves early risk stratification by Killip classes and TIMI risk score in patients with acute ST elevation myocardial infarction treated with primary angioplasty.

BACKGROUND: TIMI risk score for ST elevation acute myocardial infarction (STEMI) and Killip classes are simple tools for early risk stratification. AIM: This study aims to evaluate the hypothesis that admission of BNP adds prognostic information to Killip classes and TIMI risk score in patients with STEMI treated with primary percutaneous coronary intervention (PCI). METHODS: BNP concentrations in blood samples obtained on admission in 126 consecutive patients (mean age 58.8+/-10.7 years old) with STEMI were assessed with means of point-of-care test before PCI. A 42-day follow-up for total mortality was performed. RESULTS: BNP levels increased significantly with increasing Killip classes and TIMI risk score. Addition of BNP to Killip classes and to TIMI risk score increased area under the ROC from 0.704 to 0.887 and from 0.852 to 0.918, respectively. There was a significant increase in mortality in the subgroups by Killip classes and BNP: 1.1% for Killip I and BNP < 331 mg/ml; 16% for Killip I or BNP > or = 331 mg/ml; 55.6% for Killip I and BNP > or = 331 mg/ml; p<0.0001; and in subgroups by TIMI risk score and BNP: 0% for TIMI risk score < 4 and BNP < 331 pg/ml; 2.8% for TIMI risk score > or = 4 and BNP < 331 pg/ml; 12.5% for TIMI risk score < 4 and BNP > or = 331 pg/ml; and 50% for TIMI risk score > or = 4 and BNP > or = 331 pg/ml; (p<0.0001). In multivariate model BNP was a prognostic variable for mortality, independent from TIMI risk score. CONCLUSIONS: Admission of BNP adds significant prognostic information beyond that of Killip classes and TIMI risk score in patients with STEMI treated with PCI.

Adult↗
PubMed2006

Previously known and newly diagnosed atrial fibrillation: a major risk indicator after a myocardial infarction complicated by heart failure or left ventricular dysfunction.

AIMS: To characterize the relationship between known and newly diagnosed atrial fibrillation (AF) and the risk of death and major cardiovascular (CV) events in patients with acute myocardial infarction (MI) complicated by heart failure (HF) and/or left ventricular systolic dysfunction (LVSD). METHODS: The VALIANT trial enrolled 14,703 individuals with acute MI complicated by HF and/or LVSD. AF was assessed at presentation and at randomization (median 4.9 days after symptom onset). Primary outcomes were risk of death and major CV events 3 years following acute MI. RESULTS: A total of 1812 with current AF (AF between presentation and randomization), 339 patients with prior AF (history of AF without current AF), and 12,509 without AF were enrolled. Patients with AF were older; had more prior HF, angina, and MI, and received beta-blockers and thrombolytics less often than those without AF. Three-year mortality estimates were 20% in those without AF, 37% with current AF, and 38% with prior AF. Compared with patients without AF, the multivariable adjusted HR of death was 1.25 (1.03-1.52; p=0.03) for prior AF and 1.32 (1.20-1.45; p<0.0001) for current AF. HR for major CV events was 1.15 (0.98-1.35; p=0.08) and 1.21 (1.12-1.31; p<0.0001). CONCLUSION: AF is associated with greater long-term mortality and adverse CV events with acute MI complicated by HF or LVSD.

Acute Disease↗
PubMed2006

Attempt to eliminate health inequalities in Poland arising at the time of political and economic transformation: Polish 400 Cities Project.

AIM: Epidemiological data show that citizens of small towns and villages have presented worse trends in cardiovascular mortality during the political, social and economic transformation in Poland during past 15 years than citizens of large towns. To try to eliminate these inequalities the Polish 400 Cities Project (P400CP), a large educational and interventional project, was prepared. The project consists of two arms: medical and social interventions. MATERIAL AND METHODS: The main aim of the medical screening intervention in P400CP is to increase detection and control of cardiovascular risk factors in inhabitants of 418 small cities (<8000 inhabitants) and surrounding villages, particularly in men and people of lower education. In 2003 and 2004 the P400CP covered 123 cities. All together, 36 696 subjects aged between 18 and 98 years were examined. In all participants, blood pressure (BP), anthropometric measurements, laboratory tests and questionnaire interviews were performed. The social arm of P400CP is one of multi-level educational intervention. Modern techniques of social psychology and marketing were involved to increase participation in interventions. RESULTS: Only 12.5% of all subjects had normal BP, cholesterol (<190 mg/dl) and glucose (<100 mg/dl in whole capillary blood) levels. During the first screening visit 65.5% of all examined subjects had BP>/=140 mmHg or >/=90 mmHg. The fasting glucose level was increased in 19% of women and 26% of men. Almost two-third of all subjects had a total cholesterol level above the norm. CONCLUSIONS: The prevalence of cardiovascular risk factors in participants of the screening programme P400CP in small towns in Poland was very high. High prevalence and low control of risk factors in participants of the P400CP confirm the decision to target this programme at citizens of small towns and villages.

Adolescent↗
PubMed2006

C-reactive protein in patients with coexistent periodontal disease and acute coronary syndromes.

AIM: To evaluate periodontal disease (PD) influence on changes in high-sensitivity C-reactive protein (hsCRP) concentrations in patients with acute coronary syndromes and coexistent PD. MATERIALS AND METHODS: Dental examinations were carried out in a group of 50 consecutive patients, less than 60 years old, hospitalized as a result of acute coronary syndromes. The patients were divided into two groups on the basis of own-constructed combined PD score (group 2: more advanced; and group 1: less advanced PD) as well as clinical attachment loss (CAL) - group 4: CAL >3 mm; group 3: CAL <or=3 mm. Blood samples for hsCRP estimation were taken at admission, after 10/12 days and long term after acute coronary syndromes. RESULTS: A statistically significant decrease in hsCRP was observed among three consecutive blood sample examinations in groups 2 and 4, whereas it was only seen between examination 1 and examination 2 in groups 1 and 3. CONCLUSIONS: Although no statistically significant difference of hsCRP was found between studied groups, patients with less advanced PD, either estimated with the use of own-constructed combined score or on the basis of CAL, have significantly longer diminution of inflammatory response monitored with hsCRP concentrations.

Angina, Unstable↗
PubMed2006

[Unfortunate outcome of subsequent vascular complications in female patients assigned to percutaneous coronary intervention -- case report].

We present a case of a 58-year-old female who underwent elective PCI of the left anterior descending coronary artery. The procedure was complicated by vessel dissections and myocardial infarction. Cardiogenic shock complicated acute coronary syndrome required intraaortic balloon pumping what led to descending aortic dissection successfully treated with stent-graft implantation. However, the patient died due to intractable cardiogenic shock.

Aortic Dissection↗
PubMed2006

The prognostic value of renal dysfunction in patients with chronic heart failure: 12-month follow-up.

INTRODUCTION: Renal function assessment is an important element of management and therapeutic decision-making in patients with chronic heart failure (CHF). AIM: To evaluate the prognostic value of renal dysfunction in patients with CHF in 12-month follow-up. METHODS: 639 consecutive patients hospitalised in our department from 1 July 2002 to 31 December 2003 with diagnosis of CHF (NYHA II-IV), based on medical records, were initially enrolled in the study. Patients underwent one-year follow-up. Finally, 498 patients, aged 22-98 years (mean age 69+/-12 years) in whom creatinine concentration was measured and creatinine clearance was estimated at admission with the Cockroft-Gault quotation and with long-term follow-up results obtained, were enrolled in the study. Patients were divided into two groups according to the creatinine level: Group I without renal dysfunction (creatinine level <1.4 mg/dl), and Group II--with renal dysfunction (creatinine level >1.4 mg/dl). RESULTS: Patients with renal dysfunction were significantly older and more likely to be male and in NYHA class III-IV (p <0.001). Analysis of pharmacotherapy for CHF revealed that patients with renal impairment significantly less frequently received beta-blockers (67% vs 81%, p <0.005), angiotensin-converting enzyme inhibitors (68% vs 82%, p <0.005) and combined treatment of beta-blocker and angiotensin-converting enzyme inhibitor (56% vs 71%, p <0.05), whereas loop diuretics were more frequently prescribed in this group (80% vs 70%, p <0.05). In patients with renal dysfunction, there was a significantly higher mortality rate at 30 days (32% vs 14%, p <0.001) as well as at 12 months (45% vs 20%, p <0.001). The incidence of re-hospitalisation for cardiovascular reasons (CHF worsening, myocardial infarction, stroke) was significantly higher in patients with renal dysfunction (70% vs 55%, p <0.005). Multivariate analysis of all factors affecting one-year mortality demonstrated that renal dysfunction is a strong and independent risk factor for death in patients with CHF (RR=2.13, 95% CI: 1.31-3.45; p <0.05) and it increases the risk of re-hospitalisation (RR=1.53, 95% CI: 1.01-2.14; p <0.05). CONCLUSIONS: Renal dysfunction is an independent prognostic factor in patients with CHF, which allows identification of a high-risk group and administration of optimal therapy, which in turn can result in a reduction of mortality.

Adrenergic beta-Antagonists↗
PubMed2006

Value of transesophageal dobutamine stress echocardiography for selection of the type of cardiac surgery in significant ischaemic mitral insufficiency.

BACKGROUND: Ischaemic mitral regurgitation (IMR) may be surgically treated by isolated myocardial revascularisation or in combination with valve repair. Dobutamine stress echocardiography (DSE) may be helpful in selecting an optimal surgical strategy. AIM: To develop the optimal surgical approach to patients (pts) with significant (ERO łO2 cm(2)) IMR on the basis of TEE-DSE. An attempt was undertaken to select patients in whom coronary revascularisation should be performed alone or in combination with reconstruction of mitral apparatus. METHODS: The study group comprised 212 pts (M/F--134/78; mean age 65+/-10 years) with a history of Q-wave myocardial infarction qualified to elective surgical revascularisation on the basis of coronary angiography. In 25 pts with significant IMR (ejection fraction <40%, wall motion score index 1.8+/-0.3) TEE-DSE was performed. Based on TEE-DSE results pts were divided into the following groups: Group I--7 pts with significant reduction of MR and improvement of left ventricular contractility following dobutamine infusion and qualified to CABG; and Group II (n=18) without significant changes of IMR (9 pts) or with significant reduction of IMR without significant influence on WMSI (9 pts) who were qualified to CABG with mitral valve surgery. RESULTS: In 4 pts from Group II valve replacement was performed and the remaining 14 pts had mitral annuloplasty. Echocardiographic assessments performed 2-7 days, 6 months and 12 months following the surgical procedure revealed IMR intensity as follows (number of patients is given): Group I--small 5/4/4, moderate 2/2/2, severe 0/0/0, Group II--small 15/14/13, moderate 2/3/3, severe 0/0/0. CONCLUSIONS: TEE-DSE seems to be a useful tool for optimal selection of surgical treatment in patients with significant IMR and qualification for CABG.

Adult↗
PubMed2006

[Effect of the optimal neurohormonal blockade on long-term survival in patients with chronic heart failure].

BACKGROUND: In recent years large scale clinical trials have cleary shown that a number of pharmacological treatments can improve the outcomes of patients (pts) with chronic heart failure (CHF). AIM: The aim of this study was to assess the effect of optimal neurohormal blockade in pts with chronic heart failure on survival during 12 month follow-up. METHODS: We analyzed data on 489 pts in NYHA II-IV class of HF, referred to our Dept. (mean age was 69 +/- 12). We define doptimal neurohormonal therapy as beta-blocker and ACE-inhibitor in pts with NYHA II, and beta-blocker, ACE-Inhibitor and spironolactone in patients with NYHA III-IV class. Pts were divided into groups: group 1--optimal neurohormonal blockade (n = 232, mean age, 67 +/- 11), group 2--non-optimal neurohormonal blockade (n = 257, mean age, 70 +/- 13). Pts were followed for 12 month. RESULTS: Group with optimal therapy were frequent male gender, of ischemic aetiology, and NYHA class II (p < 0.05). Diabetes mellitus, hypertension, left ventricular ejection fraction did not differ the groups (p = NS). Pts with non-optimal therapy were more frequent with prior history of renal dysfunction and anemia at admission (p < 0.05). During 12 month follow-up 12% in optimal vs 40% in non-optimal therapy died (p < 0.005). The rehospitalisation rate during one-year was also significantly higher in pts receiving non-optimal therapy (69% vs 48%, p < 0.005). Cox multivariate analysis showed after adjusting for age, gender, etiology of HF, NYHA functional class, renal dysfunction, EF, had significantly 62% reduction in mortality and 41% reduction in cardiovascular rehospitalisation in pts receiving optimal therapy. CONCLUSIONS: The optimal neurohormonal therapy have favorable effects on outcomes in pts with CHF. This data strongly support that optimalization of care and evidence-based treatment of CHF pts can improve poor prognosis in this group.

Adrenergic beta-Antagonists↗
PubMed2006

[Apical ballooning syndrome in a 57-year-old woman during premedication for general anaesthesia].

Apical ballooning after sudden emotional stress is a new syndrome characterised by abrupt onset of angina-like chest pain, ST-segment elevation, wall motion abnormalities involving the lower anterior wall and apex without significant coronary artery stenosis. We present a case of a 57-year-old woman with apical ballooning syndrome which occurred during premedication the general anaesthesia. We also found an increased B-type natriuretic peptide level in this patent--the finding not reported previously in the literature.

Anesthesia, General↗
PubMed2005

Clinical, biochemical and genetical resistance to clopidogrel in a patient with the recurrent coronary stent thrombosis--a case report and review of the literature.

The in-stent thrombosis is considered as a serious complication of percutaneous coronary intervention. The impaired response to the antiplatelet therapy may play an important role in this crucial problem. Recurrent thrombosis can be explained by genetic background. Because the phenomenon of clopidogrel resistance is associated with an increased risk of recurrent cardiovascular events, genetic variants of a platelet receptor P2Y(12) might be the risk factor. Although there is no test recommended to assess the response to the antiplatelet therapy, the presented case suggests platelet function analysis should be undertaken in patients with recurrent stent thrombosis.

Aged↗